R560 – Tendon graft
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for a tendon graft in the foot and ankle region. The fee for each additional tendon graft performed during the same operation is payable under E053. Payment for surgical assistant and anaesthesiologist services is calculated based on a combination of basic units and time-based units as specified in the Schedule of Benefits.
When to Use
- Use R560 for the primary tendon graft procedure in the foot or ankle region.
- Use R560 as the base code when performing a single tendon graft, and append E053 for each additional tendon graft performed during the same operative session.
Common Pitfalls
- Billing R560 multiple times for multiple grafts instead of using the primary code R560 plus the add-on code E053.
- Failing to document the specific anatomical location of the graft, which is required to justify the surgical procedure in the foot and ankle region.
Billing Tips
- Ensure that E053 is only utilized for subsequent grafts performed during the same surgery, as it is strictly an add-on code to R560.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.